Knee fracture fixation describes the medical intervention employed to treat fractures/broken bones at the knee. If the broken bone punctures the skin, it is called an open or compound fracture while a closed fracture consists of a broken bone that does not puncture the skin.

Fractures commonly happen because of car accidents, falls, or sports injuries link to service page). While there are three bones at the knee– the tibia, femur and patella, several forms of fractures could manifest. A knee fracture is considered a major surgery and would require various methods and techniques to address.

Not all types of fractures require surgery. If a fracture is deemed stable, immobilisation would be sufficient for recovery. Upon immobilisation through casting and implementing the usage of a crutch or braces, you will be required to undergo physiotherapy sessions for recovery.  

Types of fractures that require surgical intervention include:

• Comminuted fracture: bone is shattered into several pieces.
• Displaced fracture: ends of the broken bone ends are misaligned.
• Open fracture:  broken bone is exposed through the skin with multiple injuries such as muscle, tendon, and ligament damage.

The fundamental objective of a knee fracture fixation is to stabilise the knee, catalyse healing, and recover mobility of the knee.

There are various approaches to treating knee fractures depending on the type of fracture sustained and the location of the fracture. In the diagnostic phase, imaging tests such as x-rays and magnetic resonance imaging (MRI) will help determine the exact location of the fracture and the most suitable surgical approach to treat it.

During the surgery, incisions are first made over the area. Muscles and other soft tissues would be cut to obtain a better view of your knee’s condition. Based on the evaluation there are 2 generalised approaches which would be taken to treat a knee fracture:

• Internal fixation

Internal fixation refers to surgical intervention conducted in the knee to hold the bone together and provide stability. It is common to have screws, wires, pins, and rods implanted to treat the damage from fractures.

• External fixation

External fixation is conducted when internal structures such as soft tissues of the knee are severely damaged. Inserting implants will further exacerbate injury thus surgery is conducted outside the knee. A structure consisting of pins, metal screws, and bars is placed on your knee externally to hold bones in position. Typically this approach is followed by an internal fixation after a significant healing period or a total knee replacement.

There are 3 types of fixation that may be performed during surgery. The suitability yet again, depends on the type of fracture and location of the fracture.

These 3 fixations are:

• Suture fixation: sutures are used to close up tears in tendons and ligaments to the bone. This method can be done by hand or using specific suture devices.
• Hybrid fixation: a combination use of screws, rods, nails, and other tools or implants and/or external implants. Hybrid may involve a combination of internal and external fixation
• Metal fixation: refers to the inclusion of metallic implants to provide additional support within the knee.

Upon completion of surgery, the site of surgery is cleaned with antiseptic solutions to prevent infections. The incisions are then closed with sutures.

• Provides quicker pain relief
• Avoids malformation of the bone
• Restores mobility
• Recovers the ability to perform daily activities
• Catalyzes bone healing

A knee fracture fixation can be used to treat the following conditions:

• Patellar fracture/fracture of the kneecap
• Proximal tibial fracture/fracture of the shin bone
• Distal femur fracture/fracture of the thighbone
• Femoral condyle fracture
• Tibial plateau fracture
• Tibial shaft fracture
• Fibula fracture

Depending on the type of fracture sustained and the method employed, the success rate varies. Painkillers and antibiotics will be prescribed to help relieve pain or discomfort, and to prevent infections post-surgery. Rehabilitation is required for you to regain mobility and functionality so physiotherapy sessions will also be arranged.

It could take up to 6 months for one to recover. However, upon completion of recovery, you can expect life to resume as normal. Complete recovery could take up to a year.

Results will vary from person to person, depending on the severity of the issue and your overall health. Your orthopaedist can give you a better idea of what to expect based on your individual needs and circumstances.

Treatment sessions or the number of surgeries solely depend on the type of fracture sustained and the method employed. If an external fracture fixation is conducted, you may have to return when injuries have healed to conduct a subsequent internal fixation or to remove the external fixator when healed. Recurrent surgery may also be required to address injuries that were previously evasive, implants have become loose over time, or if more injuries are sustained.

To attain complete recovery, one will need to attend physiotherapy sessions and appropriately manage medications such as painkillers, antibiotics, and blood thinners. The frequency of physiotherapy sessions will vary according to your condition and the ability of your knee joint.